Provider Demographics
NPI:1093167058
Name:ALL-STAR TRANSPORTATION
Entity Type:Organization
Organization Name:ALL-STAR TRANSPORTATION
Other - Org Name:ALL-STAR TRANSPORTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MAUNA RAE
Authorized Official - Middle Name:H
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-521-2955
Mailing Address - Street 1:9422 N 85TH E
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-5565
Mailing Address - Country:US
Mailing Address - Phone:208-557-4080
Mailing Address - Fax:
Practice Address - Street 1:9422 N 85TH E
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-5565
Practice Address - Country:US
Practice Address - Phone:208-557-4080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-01
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)